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Study on the therapeutic effect of eggshell membrane on osteoarthritis in rats

by Mingming Pan, Yanhua Shen, Jiayu Wu, Chaonan Liu, Meihong Zhu, Zhengyu Zhou

This study aimed to investigate the therapeutic effects of ELASEM®Flex and ELASEM®ProFlex, two eggshell membrane (EM) products, on sodium iodoacetate (MIA)-induced osteoarthritis (OA) in rats. An OA model was established by a single intra-articular injection of MIA into the knee joint. After modeling, rats were administered diclofenac sodium, ELASEM®Flex, and ELASEM®ProFlex by gavage daily for 4 consecutive weeks. During the experiment, food intake, water intake, body weight, and plantar mechanical pain threshold (MPT) of rats were measured weekly. Serum levels of TNF-α, COX-2, IL-1β, and CTX-II were assessed at weeks 2 and 4. After 4 weeks, knee joints were harvested for histopathological examination (HE staining and Safranin-O fast green staining). Results indicated that knee joints of OA rats showed significant swelling, which was alleviated to varying degrees in all treatment groups. Both ELASEM®Flex and ELASEM®ProFlex significantly increased the MPT (P ®Flex and ELASEM®ProFlex can exert preventive and reparative effects on knee OA in rats by alleviating arthritis pain, inhibiting inflammatory factor expression, reducing type II collagen degradation, and promoting chondrocyte proliferation.

A survivorship-oriented enhanced care model for patients undergoing radical prostatectomy

by Xiuqun Yuan, Yuting Chen, Huihui Lu, Pei Zheng, Yanyan Zhang, Min Chen, Xia Sheng

Objectives

Post-prostatectomy patients experience urinary incontinence, fluctuating quality of life, and psychosocial distress during early survivorship. Evidence-based nursing models addressing long-term supportive needs remain limited. This study developed and evaluated an enhanced survivorship-oriented care model designed to improve postoperative functional recovery and quality-of-life outcomes.

Methods

A retrospective study was conducted at a tertiary urologic center. The improved survivorship model was developed based on our previous PROSTATE care model, integrating nurse-led continuous follow-up, psychosocial support, and structured rehabilitation. A total of 1062 patients who underwent radical prostatectomy between June 2024 and May 2025 received the enhanced survivorship care, compared with 673 patients treated between June 2023 and December 2023 under the previous PROSTATE care model. Outcomes included urinary continence, quality of life, postoperative complications, and length of stay. Between-group comparisons were performed using independent-samples tests, and repeated-measures ANOVA was applied to assess longitudinal changes.

Results

Both groups demonstrated significant improvements in urinary recovery and quality of life over time (time × group interaction, P  Conclusion

The enhanced survivorship care model demonstrated clinically meaningful improvements in quality of life and continence recovery, while maintaining patient safety. These findings support its clinical value and potential for wider implementation as a structured survivorship strategy following radical prostatectomy.

Estimating the velocity and direction of African Swine Fever spread in wild boar populations in South Korea using Trend-Surface Analysis

by Cecilia Aguilar-Vega, Jaime Bosch, Satoshi Ito, Benjamin Ivorra, Hyunkyu Jeong, José Manuel Sánchez-Vizcaíno

African swine fever (ASF) is a lethal disease of swine that has spread across Asia since its introduction in 2018. South Korea first reported the disease in September 2019 in domestic pigs, and since then, more than 4,000 cases have been reported in wild boars during its expansion up to August 2024. Due to the high number of ASF notifications in wild boars in South Korea, contrasted with their scarcity in most Asian countries, analyzing the spatiotemporal spread of the disease in a setting with active surveillance provides valuable insights. In this study, we performed a trend-surface analysis on temporally gridded case data to characterize the overall geographic spread and direction of ASF in wild boars across South Korea, from its emergence to August 2022. Additionally, we propose a novel approach distinct from previous studies, to estimate spread velocity by incorporating an upper threshold to avoid unrealistic values. The model described the spread of ASF in the study area. The disease showed greater expansion in the east of the country. Initially, a south and eastward direction was estimated. The estimated median velocity was 19.53 km/month, with cell-level velocities ranging from 2.45 to 69.99 km/month. Velocity increased notably from autumn 2021 onward and varied substantially across years. Our results show the dynamics of ASF in wild boars of South Korea, providing new evidence of their role in the epidemiology of the disease.

Effectiveness of Mindfulness‐Based Art Therapy for Oncology Nurses: A Randomized Controlled Trial

ABSTRACT

Background

Oncology nurses are frequently subjected to significant psychological stress due to the demanding nature of cancer care, which negatively impacts their mental and physical health as well as the quality of patient care. Although Mindfulness-Based Stress Reduction has been demonstrated to be effective in alleviating stress, practitioners often encounter barriers such as limited engagement and difficulty maintaining regular practice.

Aim

To enhance engagement and adherence, we integrated art elements into the Mindfulness-Based Stress Reduction framework, creating the Mindfulness-Based art therapy program, and evaluated its effectiveness among oncology nurses.

Design

A three-arm randomized controlled trial.

Methods

90 oncology nurses participated (Mindfulness-Based Art Therapy group = 30, Mindfulness-Based Stress Reduction group = 30, waitlist controls group = 30) in an 8-week program. Stress, anxiety, depression, fatigue, and mindfulness levels were assessed at baseline, immediately after the fourth week of intervention, and immediately after the intervention concluded. Compliance and satisfaction were evaluated using attendance rates and satisfaction questionnaires. Descriptive statistics were used to analyze general data; intervention effects were compared using one-way ANOVA and generalized estimating equations, and compliance and satisfaction were compared using independent samples t-test.

Results

Both Mindfulness-Based Art Therapy and Mindfulness-Based Stress Reduction significantly improved stress, physiological markers, and mindfulness vs. controls. Mindfulness-Based Stress Reduction better reduced depression (β = −2.980, 95% CI: −5.427, −0.533, p = 0.017), while Mindfulness-Based Art Therapy was superior for fatigue (β = −11.582, 95% CI: −20.615, −2.550, p = 0.012). Mindfulness-Based Art Therapy had higher adherence (93.3% vs. 73.3%, p < 0.05) and satisfaction (3.27 ± 0.45 vs. 2.40 ± 0.52, p = 0.01).

Linking Evidence to Action

For oncology nurses, Mindfulness-Based Art Therapy is as effective as Mindfulness-Based Stress Reduction for improving stress and mindfulness, while providing greater adherence, satisfaction, and more consistent fatigue reduction.

Trial Registration

Chinese Clinical Trial Registry, ChiCTR2300078124 (http://www.chictr.org.cn), 30/11/2023

Prevalence and genotypic distribution of non-epidermolytic ichthyosis in Italian Golden Retrievers

by Maria Grazia De Iorio, Michele Polli, Sara Ghilardi, Stefano Frattini, Mara Bagardi, Alessandra Paganelli, Maria Cristina Cozzi, Kenza Seghrouchni, Paola Giuseppina Brambilla, Giulietta Minozzi

Non-epidermolytic ichthyosis (NEI) is a hereditary skin disorder affecting several dog breeds, most notably the Golden Retriever. It is primarily caused by a loss-of-function variant in the PNPLA1 gene, while a second, less common form is associated with a deletion in the ABHD5 gene. This retrospective study aimed to assess the prevalence and temporal trends of both mutations in Golden Retrievers tested in Italy between 2017 and September 2025. A total of 508 genetic tests were analyzed, including 463 dogs tested for the PNPLA1 mutation, 42 for the ABHD5 deletion, and 3 for both variants. DNA was extracted from blood or buccal samples and analyzed by real-time PCR followed by confirmatory Sanger sequencing. Among the PNPLA1 tested dogs, 42% were clears (wt/wt), 37% carriers (wt/mut), and 21% affected (mut/mut), with calculated allele frequencies of 60% wild-type and 40% mutant. A significant temporal decline in mutant allele frequency was observed, accompanied by an increasing number of animals tested over time, suggesting growing interest in genetic screening and its impact on selective breeding. Conversely, all dogs tested for the ABHD5 deletion were wild-type, supporting its rarity in the breed. Overall, these findings confirm that PNPLA1-related ichthyosis remains one of the most prevalent hereditary disorders in Golden Retrievers, although its frequency is decreasing. The results emphasize the effectiveness of genetic testing in disease prevention and highlight the importance of continued monitoring to maintain genetic health within the breed.

Effectiveness of manual diaphragmatic techniques in adults with non-specific low back pain: a systematic review and meta-analysis protocol

Introduction

Non-specific low back pain (NSLBP) is one of the leading causes of disability worldwide. Emerging evidence suggests that altered diaphragmatic function may be associated with lumbar pain, impaired trunk stabilisation and functional disability. Manual diaphragmatic techniques have been proposed as an intervention to modulate diaphragmatic tension, mobility and neuromyofascial relationships; however, their effectiveness has not yet been synthesised using rigorous systematic review methods.

Methods and analysis

This protocol follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidance and has been prospectively registered in PROSPERO. Randomised controlled trials evaluating manual techniques specifically applied to the diaphragm in adults with NSLBP will be eligible. The primary outcomes will include pain intensity and functional disability; secondary outcomes will include lumbar mobility, respiratory function, quality of life and adverse events. Searches will be performed in PubMed/MEDLINE, Cochrane CENTRAL, PEDro, CINAHL, Scopus, Embase and clinical trial registries without language or date restrictions. Two reviewers will independently perform study selection, data extraction and risk-of-bias (RoB) assessment using the Cochrane RoB 2 tool. Where appropriate, a random-effects meta-analysis will be conducted; the certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach. Substantial clinical and methodological heterogeneity is anticipated across trials, which may limit the feasibility of quantitative data pooling.

Ethics and dissemination

As this study uses data from previously published trials, ethical approval is not required. Findings will be disseminated through peer-reviewed publication, conference presentations and a plain-language summary for clinical stakeholders.

PROSPERO registration

CRD420251172616.

Cluster randomised controlled trial for service delivery redesign of primary care for people with diabetes: study protocol

Por: Mazzoni · A. · Roberti · J. · Guglielmino · M. · Jorro-Baron · F. · Mazzaresi · Y. · Falaschi · A. · Alvarez · J. · Gibbons · L. · Leslie · H. H. · Silva · C. · Garcia · P. J. · Garcia-Elorrio · E.
Introduction

Strong primary healthcare enhances resource efficiency and resilience. Type 2 diabetes poses a growing global health challenge, with Argentina’s healthcare system struggling to detect and manage the disease effectively. Many patients bypass primary healthcare for secondary facilities, undermining continuity of care and increasing costs. Following a diagnostic process in collaboration with policymakers, we propose evaluating a redesigned primary care model consisting of codesigned evidence-based implementation strategies to improve type 2 diabetes management in Mendoza, Argentina.

Methods and analysis

This is an efficient, parallel-arm cluster randomised controlled Hybrid Type II trial with 12 clusters (administrative areas with 2–3 health facilities) allocated 1:1 to control (usual care) or intervention. In phase I, we will codesign, pilot and refine an implementation strategy package. In phase II, we will conduct the trial: 9-month baseline data collection, 15-month intervention and 6-month sustainability period. We will enrol a cohort of 396 patients with type 2 diabetes at primary healthcare centres and follow them for 12 months during the intervention and 6 months sustainment using routine clinical records and patient surveys. In phase III, we will conduct analysis, report and disseminate findings. The primary outcome will be a composite outcome including glycaemic control (glycated haemoglobin (HbA1c)

Ethics and dissemination

All study activities will comply with national and international ethics guidelines, presenting minimal risk to participants. The protocol was submitted and approved by the local independent ethics committee at the Mendoza Ministry of Health (Consejo Provincial de Evaluación ética en investigación en Salud-Provincial Health Research Ethics Review Board, Reference number: 149/2024). Facility-level permission will be obtained for participation and sharing of deidentified data. Written informed consent will be required from study participants, who will receive information on the study’s purpose, procedures, risks and benefits. Dissemination activities and outputs will include writing and submitting manuscripts for publication; writing policy briefs to support strategy implementation in other regions or countries; and tailoring outputs for patients, clinicians and researchers. We anticipate that improvements in disease management and patient experience will have clinical and economic benefits related to reduced usage of secondary-level and tertiary-level facilities, lower cost per visit and a reduced number of clinical events related to diabetes.

Trial registration number

ISRCTN63277390.

The Montreal model of ketamine-therapy for alcohol use disorder and comorbid treatment-resistant depression: protocol for a feasibility trial

Por: McAnulty · C. · Lavoie · P. · Cyr · S. · Lavin · P. · Elkrief · L. · Richard-Devantoy · S. · Rizkallah · E. · Lesperance · P. · Gamin · N. · Lembke · A. · Jutras-Aswad · D. · Greenway · K. · Garel · N.
Background

Alcohol use disorder and treatment-resistant depression (TRD) often co-occur, presenting a major clinical challenge with limited effective treatments. However, ketamine produces rapid antidepressant effects and has shown promise in reducing alcohol use, and acceptance and commitment therapy (ACT) can be effective for both substance use and mood disorders. This study explores the feasibility and acceptability of combining ACT with ketamine within the framework of the Montreal Model—a structured, integrative psychedelic ketamine therapy developed for severe TRD.

Methods and analysis

This study is a single-group, open-label feasibility trial at the Centre hospitalier de l'Université de Montréal (CHUM) Neuromodulation Ketamine Clinic in Montreal, Canada. 30 participants diagnosed with both alcohol use disorder and treatment-resistant depression will receive eight weekly in-person or virtual ACT sessions in addition to six intravenous ketamine infusions. The primary outcome is feasibility, assessed through study completion and protocol adherence. Secondary outcomes include recruitment rate, tolerability, safety, data completeness and healthcare resource use. Exploratory measures will examine changes in depressive symptoms, alcohol use and quality of life using validated tools. A subset of participants will participate in semistructured qualitative interviews to explore their experiences.

Ethics and dissemination

This study was approved by the ethics committee of the CHUM on 14 May 2025. The results of the trial, including primary and secondary outcomes, will be published in peer-reviewed scientific journals.

Trial registration number

NCT06620276.

The Mediating Role of Spirituality in Delineating the Interconnection Between Self‐Efficacy and Resilience Among the Parents of Children With Newly Diagnosed Diabetes: A Community Nursing‐Led Cross‐Sectional Study

ABSTRACT

Aim

This study examined the interplay among spirituality, self-efficacy and resilience in this context.

Design

A cross-sectional study.

Method

A total of 178 parents of children newly diagnosed with diabetes mellitus; the instruments used for data collection were the Parental Self-Efficacy Scale for Diabetes Management, The Arabic version of The Walsh Family Resilience Questionnaire and the Spiritual Perspective Scale.

Results

Self-efficacy had a significant positive direct effect on family resilience. Spirituality also had a significant positive direct effect on family resilience. Additionally, self-efficacy had a significant positive indirect effect on family resilience through its effect on spirituality.

Conclusion

The findings underscore the impact of spirituality and self-efficacy on a family resilience.

Implications for the Profession

Nurses should prioritise self-care and personal reflection to enhance their spiritual well-being. This can help them better understand and empathise with their patients' spiritual needs, allowing for more effective and compassionate care.

Impact

Upon the initial diagnosis of diabetes in a child, parents undergo a profound emotional and psychological upheaval. They are faced with the daunting task of managing their child's condition while also coping with their feelings of distress, uncertainty and fear. Amidst these challenges, factors such as self-efficacy and resilience play pivotal roles in determining how parents adapt to and navigate this new reality.

Nurses can use spiritual care to give parents a sense of meaning, purpose and hope, bolstering their self-efficacy and resilience.

Reporting Method

The relevant reporting method has been adhered to, that is, STROBE.

Patient or Public Contribution

In our research, data collection is assisted by nurses working in community-based settings.

The Use of Triage in Primary Care in the UK: An Integrative Review and Narrative Synthesis

ABSTRACT

Aims

To examine the use of triage systems in primary care in the UK.

Design

Integrative literature review and narrative synthesis.

Data Sources

PubMed, EMBASE, CINAHL and Cochrane Library were searched in October 2024.

Methods

An integrative literature review was conducted following Whittemore and Knafl's (2005) five-step process. Of 1440 articles retrieved, 305 duplicates were removed, and 1086 excluded after title and abstract screening. Two additional articles were identified through citation and hand searches. Twenty studies were quality-assessed using the Mixed Methods Appraisal Tool, and data were extracted for narrative synthesis.

Results

Twenty studies were selected, including four randomised controlled trials, three quasi-experimental studies, eleven descriptive studies and two qualitative studies. The most common type of triage was telephone triage, most frequently performed by nurses. The most common health outcomes included subsequent patient re-contacts after triage, patient symptoms or complaints, current health status and patient safety. The benefits of triage included high patient satisfaction, workload redistribution, reduced GP workload and emergency department crowding, improved resource utilisation, access to care and communication. The challenges of triage included increased overall contact time, mis-triage issues, recruitment and retention challenges, the unsuitability of the decision support tool for the primary care setting and lower usage among older and less affluent groups.

Conclusions

This review examined the current use of triage in primary care in the UK, identifying common patterns in triage processes and classifications. Several benefits were identified, though some ongoing concerns about triage remain.

Impact

This paper provides essential evidence about the current use, effectiveness and challenges of triage in UK primary care. The findings can support healthcare policymakers, practitioners and researchers in planning and improving triage systems.

No Patient or Public Contribution

Integrative review.

Stroke Coordinators' Perspectives on Sustaining Use of Fever, Sugar (Hyperglycaemia) and Swallow (FeSS) Protocols. Process Evaluation Using a Sustainability Framework

ABSTRACT

Aim

To: (i) examine Stroke Coordinators' perspectives of factors influencing sustained adherence to evidence-based protocols to manage Fever, Sugar (hyperglycaemia) and Swallow (FeSS) and (ii) compare findings between hospitals with consistently high FeSS Protocol adherence versus those with consistently low or variable adherence.

Design

Qualitative descriptive process evaluation using in-depth, individual semi-structured interviews.

Methods

Hospitals that participated in ≥ 3 national stroke audit cycles were ranked by mean adherence to FeSS Protocols and stratified by consistently high, low and variable adherence. Three hospitals from each adherence strata were purposefully selected after further stratification by (i) previous participation in a FeSS Intervention study; and (ii) location (state, remoteness). Inductive thematic analysis was undertaken, with themes mapped to factors from the framework to compare findings by adherence level and contextualise the findings in relation to sustainability.

Results

Analysis of 14 interviews identified two themes [and sub-themes]: (1) Stroke Coordinator as sustainability champions and boundary spanners [maintenance of implementation strategies; fostering working relationships, communication and influence] mapped to Workforce factors, organisational and Innovation-specific factors; and (2) Hospital executive and middle management respect of stroke specialty [designated area for stroke care; recognition of stroke specialist nursing skills; previous FeSS Intervention study participation] mapped to Workforce and Political factors. Key differences by adherence groupings related to the Stroke Coordinator model, workplace configuration, and the impact of interdepartmental relationships and competing organisational directives.

Conclusion

The Stroke Coordinator role was pivotal for sustained use of evidence-based FeSS Protocols for acute stroke care, driving multidisciplinary collaboration.

Impact/Implications

Internationally, many patients do not receive evidence-based acute stroke care. Despite the proven benefits of the FeSS Protocols, consistent implementation remains a challenge. This study recognises the critical importance of a dedicated Stroke Coordinator for all acute stroke hospitals. Their advocacy for the use of evidence-based interventions is key to improving stroke outcomes.

No Patient or Public Involvement

This study did not include patient or public involvement in its design, conduct, or reporting as it focused solely on the professional experiences of stroke care providers.

Trial Registration

ACTRN 12623000445673. Registered 1 May 2023

High‐Productivity Nursing: Occupational Calling as a Moderator in the Post‐Pandemic Hospital Environment

ABSTRACT

Aims

This study investigates the impact of the hospital environment on nurse job productivity in the post-pandemic era, with a focus on the moderating role of occupational calling, based on the person-environment-occupation-productivity (PEOP) theory.

Design

A mixed-methods approach was employed, combining two-stage quantitative surveys and qualitative interviews.

Methods

In April 2022, 230 nurses from 11 Chinese public hospitals participated in a two-stage quantitative survey. Additionally, qualitative interviews were conducted with 10 nurses and 2 physicians. Quantitative data were analysed using partial least squares structural equation modelling (PLS-SEM), while qualitative data were analysed through Colaizzi's method to identify themes. To ensure the validity and reliability of the mixed-methods design, the study adhered to the Mixed Methods Appraisal Tool (MMAT) guidelines. Both sets of data were used to evaluate the relationships between hospital environments, job productivity, and occupational calling.

Results

The study found significant correlations between the hospital's indoor, spatial and sanitary environments and nurses' job productivity. Additionally, the research revealed that occupational calling moderates the relationship between indoor and spatial environments and job productivity to varying extents. However, occupational calling does not significantly moderate the impact of the sanitary environment on job productivity.

Conclusion

This study provides insights into the transformative effects on hospital environments in the post-pandemic era, emphasising the importance of combining personal intrinsic and environmental extrinsic factors to boost nursing productivity. It proposes strategies for optimising hospital indoor, spatial, sanitary environments and enhancing nurses' occupational calling, providing practical, theoretical and educational insights to healthcare policymakers and practitioners.

Patient or Public Contribution

There was no patient or public contribution in this study, as the focus was on nurses.

Multiprofessional Family Care for Women With Gynaecological Cancer

ABSTRACT

Aim

The aim of this study was to determine how family care is implemented in the care of women with gynaecological cancer from the perspective of health professionals in Finland.

Design

Multiphase convergent mixed-methods research.

Methods

This study is based on two datasets collected from one Finnish university hospital. The first dataset was collected from health professionals (n = 20) in one Finnish university hospital inpatient unit in 2023. The second dataset is based on non-participant observational cases (n = 137) of health professionals in the spring of 2024. The quantitative data were analysed using both parametric and non-parametric tests. The qualitative data were analysed using thematic analysis.

Results

The quantitative results of the first and second phases together confirm the gap between the lack of competence and the attitudes of health professionals towards their own communication skills. The qualitative results revealed two main themes: (1) increasing competence towards a more comprehensive patient care process and (2) increasing the sense of safety by sharing timely information between professionals, patients, and relatives.

Conclusion

Family-oriented working and communication between professionals is incidental and individual-dependent. Increased competence and more effective sharing and exchange of care information between professionals can improve the quality of care.

Implications for the Profession and/or Patient Care

The study was able to identify important areas of family care for professionals to improve their clinical practice.

Impact

This study addressed clinical competence, as demonstrated by the family care perspective. Family care is recognised as an important part of the care of gynaecological cancer patients and requires increased competence. This study aims to raise awareness among health professionals and policymakers about the current state of family care in Finland.

Reporting Method

This study was prepared and reported according to the STROBE checklist.

Patient or Public Contribution

No patient or public contribution.

Nurse Educators' Background, Education, and Experience in Digital Competence Profiles: A Descriptive Comparative Cross‐Sectional Study in Four Countries

ABSTRACT

Aim

To identify and compare the digital competence profiles of nurse educators, the background variables associated with profiles, and the self-assessed level of digital competence in four European countries.

Design

A descriptive comparative cross-sectional study.

Methods

Data were collected from nurse educators (n = 263) in 36 nursing education organisations in Finland, Malta, Slovakia and Spain. Partitioning around medoids (PAM) clustering was used to identify competence groups, and descriptive and inferential statistics were used to examine the association of nurse educators' background variables.

Results

The clustering analysis resulted in two nurse educator digital competence profile groups: high and moderate. The profiles differed based on completed pedagogical studies and teaching experience, with an emphasis on the high competence profile. Educators in the high competence profile group showed greater interest in using educational technology and self assessed their digital competence at a higher level compared to educators in the moderate competence profile group. Nurse educators' lowest digital competence was in the safe and responsible use of technology, such as knowing copyright laws.

Conclusion

Despite the heterogeneous background of nurse educators, international continuing professional development needs in digital competence are identified. Nurse educators' continuing education should support the utilisation of technology through pedagogical approaches, and educators' competence in the safe and responsible use of technology (e.g., how to protect digital materials) must be enhanced in nursing education organisations.

Implications for the Profession

This study highlights the need to further develop nurse educators' digital competence. Continuing professional development should target preparation in safe and responsible technology use and include pedagogical studies and mentoring from experienced peers.

Reporting Method

The STROBE checklist was adhered to in reporting the results.

Patient or Public Contribution

Each participating educational organisation assigned a contact person to distribute the survey to the nurse educators.

The Effect of Holistic and Humanistic Approach on Professional Pride in Nursing Care

ABSTRACT

Aim

This study examines the effect of nurses' holistic nursing competency levels and humanistic behaviour skills on their professional pride levels.

Design

The study was designed as a cross-sectional study.

Methods

The sample consisted of 224 nurses working in a city hospital. The data were collected using the Personal Information Form, the Holistic Nursing Competence Scale, the Humanistic Behaviour Skill Scale in Nursing Practices and the Pride in Nursing Profession Scale. Independent groups t-test, ANOVA, and regression analyses were applied to analyse the data.

Results

The mean ± standard deviation of the total score of the nurses participating in the study from the Holistic Nursing Competence Scale was 170.48 ± 42.41, the mean ± standard deviation of the total score from the Humanistic Behaviour in Nursing Practice Scale was 121.35 ± 20.81, and the mean ± standard deviation of the total score from the Pride in Nursing Profession Scale was 79.65 ± 22.80. A statistically significant positive relationship was found between the Holistic Nursing Competence Scale and the Humanistic Behaviour in Nursing Practice Scale. The results showed a statistically significant relationship between the Holistic Nursing Competence Scale, the Humanistic Behaviour in Nursing Practice Scale and the Pride in Nursing Profession Scale. In addition, it was determined that nurses' holistic and humanistic behaviour skills explained 12.2% of the change in professional pride. The holistic nursing competencies and professional pride levels of nurses who willingly chose the nursing profession and loved their profession were found to be statistically significantly higher (p < 0.05).

Conclusion

Nurses demonstrated above-average holistic and humanistic competencies, yet their professional pride remained below average. This indicates that professional pride may be shaped not only by individual skills but also by external factors such as working conditions and societal perceptions of the profession.

Implication for the Profession and/or Patient Care

These findings suggest that to increase professional pride among nurses, not only is the development of individual competencies insufficient, but also the improvement of workplace environments and greater societal appreciation of the profession are necessary. Without addressing systemic and societal challenges, the development of holistic and humanistic nursing competences may have a limited impact on professional satisfaction. On the other hand, nurses' provision of care services in line with holistic and humanistic principles positively affects their professional satisfaction and the quality of patient care, patient satisfaction, safety and general health outcomes.

Reporting Method

This study adhered to the STROBE criteria.

Development and Psychometric Testing of a Low Extremity Lymphedema Risk Management Behaviours Questionnaire for Patients With Gynecologic Cancer

ABSTRACT

Background

Lower extremity lymphedema (LEL) is a debilitating complication for patients with gynecologic cancer. A series of strategies have been recommended to mitigate the risk of LEL and improve patient outcomes; however, investigation into LEL risk management behaviours in this population is limited, and the absence of reliable and valid tools is an important reason.

Aims

To develop and evaluate the psychometric properties of the lower extremity lymphedema risk management behaviours questionnaire (LELRMBQ) for Chinese patients with gynaecologic cancer.

Design

This was a methodological study.

Methods

Initial items were generated using a literature review. The initial LELRMBQ was refined, and its content validity was evaluated by conducting two rounds of expert consultation and a pilot study. Psychometric testing of 389 participants recruited by convenience sampling was conducted from December 2022 to June 2023. Exploratory factor analysis (EFA; subsample 1, N = 158) and confirmatory factor analysis (CFA; subsample 2, N = 231) were performed separately to determine the multi-dimensional structure of the questionnaire. Known-group validity, internal consistency reliability, and test–retest reliability were also evaluated.

Results

A total of 25 items with satisfactory content validity were included in psychometric testing. The EFA identified a four-factor structure, comprising 18 items, which explained 74.49% of the total variance. The CFA supported this structure with acceptable fit indices. Known-group validity was partially supported by significant differences in total LELRMBQ scores among groups with different education levels, residence, cancer type, and LEL awareness. Internal consistency and temporal stability were acceptable.

Conclusions

The 18-item LELRMBQ demonstrated sufficient reliability and validity as a tool for measuring LEL risk management behaviours in patients with gynaecologic cancer.

Implications for the Profession and/or Patient Care

The LELRMBQ has potential applicability in assessing LEL risk management behaviours, identifying gaps in educational practices, tailoring effective interventions, and evaluating intervention effectiveness.

Reporting Method

This manuscript followed the STROBE guidelines.

Patient or Public Contribution

Patients with gynecologic cancer participated in this study and provided the data through the survey.

Best Evidence Summary of Digital Therapeutic Interventions for Self‐Management in Patients With Hip Fractures: An Integrative Review

ABSTRACT

Aim

To consolidate the best evidence on digital therapeutic interventions for self-management in patients with hip fragility fractures, providing a foundational guide for clinicians in developing digital therapy-based self-management plans.

Design

Integrative review.

Data Sources

A comprehensive electronic search was conducted across multiple databases, including UpToDate, BMJ Best Practice, Joanna Briggs Institute, Health and Clinical Excellence, Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Chinese databases like China National Knowledge Infrastructure and SinoMed. This study retrieved papers published from the establishment of the database to September 2023.

Review Methods

Studies were selected based on inclusion criteria, such as relevance to hip fragility fractures and self-management through digital therapies. Quality assessments were conducted independently by two reviewers using established tools for each type of study, ensuring the inclusion of high-quality evidence.

Results

Fifteen studies were included: 4 guidelines, 5 expert consensus documents, 5 systematic reviews and 1 evidence summary. From these, 26 best practices were identified across 4 domains: digital design, self-management influencing factors, intervention plans and intervention content.

Conclusion

This integrative review provides a comprehensive, evidence-based summary of digital therapeutic interventions for self-management in patients with hip fragility fractures. The findings offer healthcare professionals a scientific basis for integrating digital therapy into clinical practice, highlighting its potential to enhance patient self-management.

Impact

This review underscores the value of digital therapies in empowering patients to take an active role in their rehabilitation, potentially improving adherence to self-management strategies and long-term outcomes.

Patient or Public Contribution

No patient or public contribution was used for this study.

Health‐Promoting Lifestyle and Associated Factors Among Head and Neck Cancer Patients in Northeast China: A Cross‐Sectional Study

ABSTRACT

Objectives

Health-promoting lifestyle (HPL) is strongly associated with health outcomes. In clinical practice, health-promotion behaviours in patients with head and neck cancer (HNC) are not good, which seriously affects patients' prognosis. This study aims to investigate the current status and influencing factors of HPL in HNC patients.

Design

A cross-sectional study.

Methods

This study used a convenience sampling method to select 264 consecutive HNC patients who attended a tertiary hospital in northeast China from November 2023 to May 2024 for the survey. Data were collected using the Questionnaire for General Information, the Health-Promoting Lifestyle Profile Revised-II (HPLP-II R), the Health Literacy Management Scale (He LMS) and the Acceptance of Illness Scale (AIS).

Results

The HPLP-II R scores of HNC patients were generally average (93.10 ± 15.60), with the highest scores on the nutrition dimension and the lowest scores on the exercise dimension. HPL was significantly and positively correlated with health literacy and disease acceptance. Multiple linear regression analysis showed that educational level, cancer recurrence, health literacy and disease acceptance were the influencing factors of HPL among patients with HNC, which altogether explained 25.9% of the total variance.

Conclusion

The HPL of HNC patients is at an average level and still has much room for improvement. Patients with high literacy levels, cancer recurrence, high health literacy and disease acceptance levels had relatively high levels of HPL.

Implications for the Profession

HPL can enhance patients' internal motivation, enhance their self-management ability and improve their daily functional performance while reducing complications and improving their quality of life. This suggests that medical staff should give personalised health guidance according to patients' different health literacy in clinical work, improve patients' disease acceptance and pay attention to the development of HPL.

Reporting Method

STORBE guidelines.

Patient or Public Contribution

No patient or public contribution.

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